58 year old healthy, active female with high coronary artery calcium

Any carb and protein raises insulin levels, but carbs do so at a much higher rate than do proteins. Fats don't raise an insulinic response at all.

Carbs are found in all plants. All of them. And their seeds and nuts. This includes chickpeas, green peas, green beans, any root 'vegetable', and all leafy vegetables. You'll get 8.5 gm of carbs in 100 grams of Brussels sprouts. Not bad, and you are eating the leafy green. For chickpeas, almost 20 gms of carbs in 100 gms. Quite a difference. They may be a better carb (more fiber), but it's still a carb...and the insulin will still rise for you in response.

If you are trying to lose weight, watch the dairy. Milk yields most of its calories in lactose...a sugar...meaning an insulinic response. Yoghurt is much better. For those with AF and a calcium trigger, again...watch the dairy!!

Oils do NOT harm the endothelium....not as a blanket statement. It's like saying cars kill people. Rancid oils will. So, eat only nuts and seed oils that are fresh. Walnuts stored on a pantry shelf will go rancid inside of a few weeks. Olive oils and sesame oils, both great fats, will go rancid over several weeks at room temperature once opened. If you don't consume all of your liter of oil inside of about five/six weeks, you're getting more inflammation, particularly if it isn't refrigerated. The sources I have seen, none of them especially credible (cooking sites, no research papers) say between 6-9 months for sesame seed oil once opened, less if it is 'toasted.' Ground flaxseed, a fave for many people, is good also for several months once opened, but only if refrigerated.

Here's a recent study on olive oil - https://www.ahajournals.org/doi/10.1161/JAHA.124.035034
If you are prediabetic or diabetic - you want to keep fats low and low on the glycemic index. Oatmeal and lentils don't raise blood sugars for everyone.

Dairy and cancer - https://nutritionfacts.org/video/friday-favorites-dairy-and-cancer/
Dr. Greger has evidence based science - references
Aune D, Navarro Rosenblatt DA, Chan DS, et al. Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies. Am J Clin Nutr. 2015;101(1):87-117.
Yang M, Kenfield SA, Van Blarigan EL, et al. Dairy intake after prostate cancer diagnosis in relation to disease-specific and total mortality. Int J Cancer. 2015;137(10):2462-2469.
Park SW, Kim JY, Kim YS, Lee SJ, Lee SD, Chung MK. A milk protein, casein, as a proliferation promoting factor in prostate cancer cells. World J Mens Health. 2014;32(2):76-82.
Nielsen TS, Höjer A, Gustavsson AM, Hansen-Møller J, Purup S. Proliferative effect of whey from cows' milk varying in phyto-oestrogens in human breast and prostate cancer cells. J Dairy Res. 2012;79(2):143-149.
Melnik BC, John SM, Carrera-Bastos P, Cordain L. The impact of cow's milk-mediated mTORC1-signaling in the initiation and progression of prostate cancer. Nutr Metab (Lond). 2012;9(1):74.
Aune D, Lau R, Chan DS, et al. Dairy products and colorectal cancer risk: a systematic review and meta-analysis of cohort studies. Ann Oncol. 2012;23(1):37-45.
Veettil SK, Ching SM, Lim KG, Saokaew S, Phisalprapa P, Chaiyakunapruk N. Effects of calcium on the incidence of recurrent colorectal adenomas: A systematic review with meta-analysis and trial sequential analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(32):e7661.
Ornish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005;174(3):1065-1069.
Frattaroli J, Weidner G, Dnistrian AM, et al. Clinical events in prostate cancer lifestyle trial: results from two years of follow-up. Urology. 2008;72(6):1319-1323.
Ornish D, Magbanua MJ, Weidner G, et al. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci USA. 2008;105(24):8369-8374.
Stockwell T, Zhao J, Naimi T, Chikritzhs T. Stockwell et al. response: Moderate use of an “intoxicating carcinogen” has no net mortality benefit—is this true and why does it matter?. J Stud Alcohol Drugs. 2016 Mar; 77(2):205-207.
Gonzales JF, Barnard ND, Jenkins DJ, et al. Applying the precautionary principle to nutrition and cancer. J Am Coll Nutr. 2014;33(3):239-246. 7
Daube M. Alcohol's evaporating health benefits. BMJ. 2015;350:h407.
Parkin DM. International variation. Oncogene. 2004;23(38):6329-6340.
Harrison S, Lennon R, Holly J, et al. Does milk intake promote prostate cancer initiation or progression via effects on insulin-like growth factors (IGFs)? A systematic review and meta-analysis. Cancer Causes Control. 2017;28(6):497-528.
Scrimshaw NS, Murray EB. The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. Am J Clin Nutr. 1988;48(4 Suppl):1079-1159.

Please, rochelle, stop making definitive statements, like "dairy causes cancer," or "alcohol causes cancer." You've done this sort of thing in this forum often. Please stop.

I have granola for breakfast. We make our own with oatmeal and nuts and honey. Is there an alternative to the oatmeal? I do have blood sugar issues.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7400945/
This article clearly states that legumes, including chickpeas, can (not 'do') yield a reduced glycemic response (their term), but it does not say that such foods produce NO glycemic response. So, I'll say it again: carbs = insulin. Just ask anyone knocked out of ketosis by a couple of mouthsful of chickpeas. Or, by eating just ten or fifteen blueberries, also an excellent food.

This is not to say that incorporating carefully measured volumes or mass of whatever a reasonably diet might include, with all its benefits, should be eschewed just because of even a low glycemic index. Eating sensibly, carefully, and mindful of the results of ingesting most anything is a responsible way to eat.

https://www.january.ai/blog/oatmeal-alternatives
This article says that the least processed foodstuffs are bette for you, and that adding a few tsp of oat bran will really help to reduce the glycemic impact of your breakfast. The milk won't help if you add it since most of milk's calorific content comes from sugar. Berries, bananas, raisins, dates, even walnuts, will improve the meal (for some who enjoy adding things to oatmeal) but it will also likely raise the glycemic index.

Steel cut oats, if that's all the processing it has, is going to be somewhat better than rolled oats, especially if we're talking about the 'quick' or 'minute' oats with is almost pure carbohydrate. But it's still a grain, and grains have a hefty carb content.

From the American Cancer Association - https://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet

I use whole oats (whole grain). I cook a batch in my pressure cooker. I add berries, chia seeds or basil seeds, freshly ground flax seed, dash of cinnamon etc., and soak in non-dairy milk. I stay away from honey for now since it is sugar. this combination is not fluctuating my blood sugar that much.

I looked at this paper to try to begin to understand what might be a reasonable exercise routine for myself. I enjoy jogging and biking and I'd like to do what I can while staying protecting against plaque progression.

I am wondering if anyone understands why they would use METs to classify intensity. I would think that heart rate and blood pressure would be the important factors in CAC progression. The MET value is based on running pace, but the heart rate and blood pressure of a 70 year woman at a given pace is going to be very different that the heart rate and blood pressure of a 20 year old man. I guess the group was 50-60 year old men, but I'd guess there would be some variation in pace a "moderate intensity" by RPE or heart rate.

So what is the take away? Avoiding "very vigorous" should be safe, but what is "very vigorous" for someone that isn't a 50-60 year old man. Guess I should leave the interpretation to the professionals, but it's really hard to find someone that knows where I live. When I asked my cardiologist about training for a half-marathon, he asked me "Why would you want to do that?" And there is one cardiologist in my rural area. I have to drive two hours to go to someone else. Which I guess maybe I should. 🙂

Mayo Clinic has A podcast called “Aging Forward” you may like, particularly episodes from August 22 and January 9. I’d love to hear what you think. I’m am kinda partial to the one about improving cardiovascular health because my cardiologist, Stephen Kopecky is the guest. The other, optimizing health through exercise is next on my “listen” list.
https://redcircle.com/show/1ed238fd-45a5-4f80-9a38-474784a20789